​                                        Pulse​ ​System:​ ​Pulsed​ ​Magnetic​ ​Cellular​ ​Exerciser  Informed Consent for Session or Sessions
  
  I​ ​____________________________,​(the typed name you submit for electronic submission will serve as the fill in the blank for this form) ​hereby​ ​request​ ​a​ ​Pulsed​ ​Magnetic​ ​Cellular​ ​Exercise​ ​session.​ ​I​ ​understand​ ​that​ ​the  Pulse​ ​System​ ​creates​ ​a​ ​fully​ ​adjustable​ ​pulsed​ ​magnetic​ ​field.​ ​I​ ​understand​ ​that​ ​the​ ​information​ ​shared​ ​by​ ​the  demonstrator​ ​are​ ​his/her​ ​personal​ ​opinions​ ​and​ ​are​ ​intended​ ​for​ ​educational​ ​purposes​ ​only.     

Product​ ​Disclaimer  The​ ​Pulse​ ​System​ ​produces​ ​magnetic​ ​field​ ​energy,​ ​which​ ​passes​ ​freely​ ​through​ ​tissue​ ​for​ ​the​ ​purpose​ ​of​ ​cellular  exercise​ ​to​ ​promote​ ​and​ ​support​ ​a​ ​sense​ ​of​ ​wellbeing.​ ​The​ ​FDA​ ​has​ ​not​ ​evaluated​ ​the​ ​Pulse​ ​System.​ ​It​ ​is​ ​not  intended​ ​for​ ​the​ ​diagnosis,​ ​treatment​ ​or​ ​cure​ ​of​ ​any​ ​medical​ ​condition.​ ​The​ ​Pulse​ ​System​ ​is​ ​not​ ​a​ ​medical​ ​device​ ​and  we​ ​cannot​ ​make​ ​any​ ​claims​ ​that​ ​we​ ​can​ ​affect​ ​medical​ ​conditions.     We​ ​understand​ ​this​ ​general​ ​statement​ ​regarding​ ​pulsing​ ​magnetic​ ​fields​ ​to​ ​be​ ​accurate: 

“​PEMF (pulsed electromagnetic field) devices do not treat a specific condition. Instead they optimize the body’s natural  self-healing and self-regulating function"​​ ​--​Dr.​ ​Magda​ ​Havas​ ​Associate​ ​Professor​ ​of​ ​Environmental​ ​&​ ​Resource​ ​Studies​ ​at​ ​Trent​ ​University   

Do​ ​not​ ​use​ ​if: 

• you​ ​have​ ​an​ ​implanted​ ​electronic​ ​device​ ​including:​ ​pacemaker,​ ​defibrillator,​ ​cochlear​ ​hearing​ ​device,​ ​spinal  stimulator,​ ​etc. 
• you​ ​are​ ​pregnant or could be
• you​ ​are​ ​actively​ ​bleeding,​ ​hemorrhaging,​ ​or​ ​during​ ​heavy​ ​menstruation. 
• if you have a history of seizures or blood clots please bring a doctors note prior to doing a sessions
• you have ever had an organ transplant

​ Before​ ​beginning​ ​a​ ​PEMF​ ​Exercise​ ​Session​ ​remove​ ​​ ​the​ ​following​ ​from​ ​your​ ​person:​

​Electronic​ ​or​ ​battery​ ​operated​ ​devices,​ ​keys,​ ​wallets,​ ​cards​ ​with  magnetic​ ​strips​ ​such​ ​as​ ​credit​ ​cards​ ​and​ ​hotel​ ​keys,​ ​​ ​jewelry​ ​and​ ​hearing​ ​aids. cellphones, laptops, etc.

If​ ​you​ ​are​ ​unsure​ ​whether​ ​pulsed​ ​magnetic​ ​cellular​ ​exercise​ ​is​ ​right​ ​for​ ​you,​ ​consult​ ​with​ ​your​ ​licensed  health​ ​care​ ​provider(s) 

During​ ​a​ ​PEMF​ ​Exercise​ ​Session if​ ​you​ ​experience​ ​natural​ ​reactions​ ​that​ ​include​ ​but​ ​are​ ​not​ ​limited​ ​to​ ​nausea,​ ​headache,​ ​fatigue​ ​or​ ​any  uncomfortable​ ​sensations​ ​we​ ​recommend​ ​you​ ​suspend​ ​the​ ​session​ ​and​ ​consult​ ​your​ ​doctor   

Beyond​ ​what​ ​is​ ​stated​ ​above,​ ​I_________________________,​ ​(name submitted electronically) understand​ ​that​ ​other​ ​risks​ ​associated​ ​with​ ​a​ ​pulsed  magnetic​ ​exercise​ ​session​ ​are​ ​unforeseeable​ ​and​ ​that​ ​the​ ​demonstrator,​ ​the​ ​manufacturer,​ ​the​ ​marketer,  employees,​ ​agents​ ​and​ ​affiliates​ ​cannot​ ​accept​ ​any​ ​liability​ ​for​ ​loss​ ​or​ ​damages​ ​incurred​ ​as​ ​the​ ​result​ ​of​ ​the​ ​Pulse  System​ ​session.​ I release now and forevermore all liability from  Angela A Dockter, or Angela A Dockter, LLC, or any host, organizer/homeowner/renter, or landlord of any office of any PEMF sessions I attend anywhere for any reason at anytime. I freely choose to participate in PEMF session or sessions and feel adquately informed to do so and I accept all liablity for my health and wellness choices using PEMF. I further understand Angela is a Traditional Naturopath and Quantum Energy Practitioner and NOT a licensed medical provider and she does not diagnose nor prescribe medications or supplements and her advice is not to be replaced with the advice of a licensed medical practitioner. Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Angela A Dockter  and Angela A Dockter, LLC from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

​I​ ​reserve​ ​the​ ​right​ ​to​ ​use​ ​the​ ​knowledge​ ​I​ ​have​ ​gained​ ​in​ ​the​ ​care​ ​of​ ​my​ ​own​ ​body​ ​in​ ​any​ ​legal  manner​ ​I​ ​may​ ​choose.​ ​I​ ​have​ ​read​ ​this​ ​form​ ​and​ ​voluntarily​ ​agree​ ​to​ ​the​ ​Pulse​ ​System​ ​session​ ​on​ ​my​ ​person  assuming​ ​all​ ​liability​ ​for​ ​any​ ​and​ ​all​ ​results​ ​or​ ​consequences.  My electronic signature in the form below will stand as legal and binding on the date of submission.